36D2087379 CLIA NUMBER - PROMEDICA FREMONT MEMORIAL HOSPITAL POC

Laboratory Demographics

  • CLIA Code: 36D2087379
  • Facility Name: PROMEDICA FREMONT MEMORIAL HOSPITAL POC
  • Facility Address: 715 S TAFT AVENUE, ATTN LAB MGR
    FREMONT, OH
    ZIP 43420
  • Facility Phone: 419 333-6610
  • Facility Type: Hospital
  • Facility Type: Microscopy
  • Lab Director: NIKI STAMOS KOTEVSKI
  • NPI Number: 1902185655
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2087379
LAB Type Hospital
Facility Name PROMEDICA FREMONT MEMORIAL HOSPITAL POC
Street 715 S TAFT AVENUE, ATTN LAB MGR
City FREMONT
State OH
ZIP 43420
Phone 419 333-6610
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/24/2024
Certificate Expiration Date 11/23/2026
Facility Type Hospital
Lab Director NIKI STAMOS KOTEVSKI

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This page was last updated on: 6/4/2025